Strategic Business Analyst (Consultant) – CMS Interoperability & Medicaid

We are seeking a Strategic Business Analyst with deep expertise in CMS Interoperability mandates and Medicaid programs. This is not a traditional BA role focused on BRDs and IT documentation—this role requires someone who can interpret federal regulations, perform impact analysis, and deliver executive-level insights that shape program strategy. The ideal candidate will bring consulting experience, strong leadership presence, and the ability to engage with senior executives and challenging stakeholders. Key Responsibilities: • Analyze and interpret CMS Interoperability & Prior Authorization mandates. • Conduct gap assessments of business processes and systems against CMS rules. • Provide executive-level insights, impact assessments, and roadmaps. • Act as a trusted advisor to program leadership, influencing compliance strategy. • Facilitate discussions with business owners, IT teams, and executive stakeholders. • Leverage strong knowledge of FHIR, ASC X12, and healthcare data exchange. • Track CMS timelines and support compliance readiness planning. Qualifications: • 7+ years’ experience as a Business Analyst or Consultant in healthcare IT, payer/provider, or government programs. • Proven experience engaging with executives and handling tough clients. • Strong knowledge of HL7 FHIR standards and CMS interoperability mandates. • Medicaid program experience required; Medicare knowledge a plus. • Excellent communication, facilitation, and leadership presence. • Strong consulting mindset with ability to turn regulations into actionable strategies. Preferred: • Experience with health plans, managed care, or state Medicaid agencies. • Familiarity with claims, prior authorization, and EHR systems. • Understanding of API frameworks and data mapping.